My daughter may have had a heart attack after delivering her baby

Hi.  My daughter is a 35 year old woman who just gave birth to her first child.  She has never had any trouble with her heart or with high blood pressure.  The pregnancy was ok and the labor went well.  It was a scheduled delivery.  She was given an epidural and delivered within 5 hours.  However, about 1 1/2 days after giving birth her blood pressure began rising and she started having severe chest pains, upper back pain, and tingling down one arm.  

The doctors did an angiogram because her ecg was not normal.  They were afraid she might have a tear in an artery.  After the angiogram they said everything looked good and if it was a tear that it must have started to heal itself.  They put her on statins, nitro-glycerin, blood thinners, etc. to stop another attack and help lower her pressure.  The following day they informed her that her liver enzymes were elevated and the heart enzymes were also elevated.  Due to the heart enzymes being elevated they said this shows that she had a heart attack.  The liver enzymes being elevated they said was due to developing pre-eclampsia after giving birth.  Two different doctors said they think she had a heart attack and yet her ob/gyn says she thinks the pre-eclampsia set off the events and she probably had heart spasms.  What is the difference between her having a heart attack or heart spasms?  We are so confused and do not know if really it is the same thing or different.  Would heart enzymes be elevated with both conditions?  What causes the heart enzymes to elevate?  A couple days in the ICU and many blood test they say her enzymes levels are much improved.  She is scared but we need to know what we are facing and what all of this really means.  Thanks in advance for your advice, opinions, and suggestions!!


Your daughter's problem could  been caused by a variety of problems associated with pregnancy that include pre-eclampsia, Peripartum cardiomyopathy (PPCM), or coronary artery spasm. Liver enzymes are often elevated with the first two, but some of the elevated cardiac enzymes are the same as found in the placenta and therefore don't necessarily mean heart damage has occurred. With pre-eclampsia there should be associated proteinuria (protein in her urine) and findings of a decreased renal function.

The best way forward is to check her heart with a Cardiac ECHO that will show whether there is any loss of function, suggestive of an MI or cardiomyopathy (read below). Stress ECHOs are the test of choice to look for coronary artery disease during and after pregnancy. Likewise, nuclear imaging can be performed safely.

If those ECHOs show her recovery is complete, the prognosis is excellent.

Very important: Your daughter should get a full explanation from her doctors once a final diagnosis is made. Often doctors do not know why any of these possible diagnoses happen, but  none of them are due to anything that she did or did not do. It should also include a discussion about the future, including potential other pregnancies.

Hope this helps,
Dr T


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